ORIGINAL ARTICLE

Accuracy of video imaging for predicting the soft tissue profile

after mandibular set-back surgery

Serge Kazandjian, DDS, MS,a Glenn T. Sameshima, DDS, PhD,b Thad Champlin, DDS, MS,c and
Peter M. Sinclair, DDS, MSD,d
Los Angeles, Calif.

The purpose of this study was to compare the accuracy of two video-imaging programs for predicting the
soft tissue outcomes of mandibular set-back surgery for patients with skeletal class III malocclusion. The
sample consisted of 30 previously treated, nongrowing, white patients who had undergone isolated
mandibular set-back surgery. An objective comparison was made of each program’s cephalometric
prediction using a customized analysis, as well as a subjective comparison of the predicted images as
evaluated by a panel of six raters. The results showed that both programs produced similar cephalometric
and video image predictions. The cephalometric visual treatment objective predictions were found to be
most accurate in the horizontal plane; approximately 30% of cases showed errors greater than 2.0 mm,
whereas in the vertical plane, the error rate was greater (50%). The resulting video image predictions were
judged by the panel as being in the “fair” category. A particular problem was noted when significant vertical
compression of the soft tissue images was required. Video imaging was suitable for patient education but
not accurate enough for detailed diagnosis and treatment planning. (Am J Orthod Dentofacial Orthop
1999;115:382-9)

When the treatment objectives for a
patient with a skeletal class III malocclusion cannot be
achieved by growth modification because the patient is
no longer growing, and the amount of tooth movement
that would be required is larger than “The Envelope of
Discrepancy” suggests is appropriate,1,2 orthognathic
surgery becomes the primary treatment alternative. The
patient’s esthetic concerns then become a principal fac-
tor in deciding2-6 if the surgery will involve one or two
jaws; 70% of Class III cases involve the maxilla as part
of the malocclusion’s causes.1 Surgical repositioning of
the maxilla strongly influences the profile, particularly
the naso-labial angle and the upper lip areas.2 It can
also influence the lower lip through the relocation of
Submitted by Dr S. Kazandjian in partial fulfillment of the requirements for the
degree of Master of Science in craniofacial biology at the University of South-
ern California.
aFaculty Member, Department of Orthodontics, University of Geneva.
bAssistant Professor, Department of Orthodontics, University of Southern
California.
cAssistant Professor, Department of Orthodontics, University of Southern
California.
dProfessor and Chairman, Department of Orthodontics, University of Southern
the upper incisors.1,2 Similarly changes in the mandible
not only influence the lower lip, but also the labio-men-
tal fold, and the neck-chin angle.1,2 Thus it is very
important to be able to evaluate not just the dental and
skeletal results, but also the esthetic outcomes of any
proposed surgical procedure to correct a Class III mal-
occlusion.6-9 It may be difficult for the practitioner to
communicate with patients the differences between
different potential esthetic outcomes of treatment
because it is hard for many lay people to imagine the
results of the surgery without a visual reference.7,10
Therefore, the introduction of video imaging has the
potential to represent a significant advance in the field
of both orthodontic and orthognathic prediction.3,4,6,8
All previous techniques to predict surgical goals
focused primarily on the lateral cephalogram,11-20
which is certainly important but of little direct concern
to the patient. Because the patient is often principally
interested in determining what he or she will look like
after treatment,2,10 video imaging has the potential to
radically improve the nature and sophistication of the
pretreatment communication between the patient and

California.
the doctor regarding the potential esthetic outcomes of
Reprint requests to: Dr. Peter Sinclair, Professor and Chairman, Department of the treatment alternatives being considered.3,4,6,7,21
Orthodontics, USC School of Dentistry, 925 W. 34th Street, Los Angeles, CA Currently, there are three prediction techniques
90089-0641
Copyright © 1999 by the American Association of Orthodontists.
available for orthognathic treatment planning.2,22 The
0889-5406/99/$8.00 + 0 8/1/91706 first involves cutting different parts of an acetate tracing
382
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 4
and repositioning them manually at the location the
practitioner feels is most likely to represent the treatment
outcome.2,12,22 However, in this case, there is no true
visual representation of the likely result, just a line draw-
ing. The second technique is simply a computerization of
the first, whereby digitization of the usual cephalometric
landmarks is done by the operator, and the repositioning
of the different parts is done by specialized computer
software programs.2,22 Even if this method is more con-
venient and impresses the patient, the information that is
produced is no different from the first technique. The
third prediction technique incorporates video imaging.
The basic difference lies in the additional step of super-
imposing the patient’s lateral photograph onto the
cephalogram. When the computerized prediction is pro-
duced, the facial image can be superimposed on the trac-
ing and the patient can now have an idea of his or her
probable facial appearence.2-4,17,23 The main limitation
of current systems is that the computer moves parts of
the image as “blocks.” The soft tissue boundaries
between the moving parts may not be totally blended by
the computer. In order to complete the prediction, the
clinician may have to modify the soft tissue contour in
these areas. This requires operator expertise in order to
achieve a realistic modification of the image. It is impor-
tant for patients to understand that the image produced is
a simulation, which may be similar to but not identical
with their final facial appearance.21-24
In spite of its limitations, this latest method has two
major advantages over previous techniques.3,4 First, the
tracing can be kept in the computer memory and can be
recalled easily in order to produce several alternative pre-
dictions much more rapidly than with other techniques.
The second advantage of video imaging lies in the
enhancement of the doctor-patient communication,3,6,7,10
in that it promotes greater understanding and satisfaction
with the outcome, as long as the patient recognizes that the
prediction is only a goal and not a guarantee. Sarver et al3
have found that 89% of a sample of patients judged video
images to be realistic and thought that the goal was
achieved. In addition, 83% of patients said that it helped
them to make a decision to choose the treatment. Finally,
72% felt that it also allowed them to be an integral part of
the treatment process. Similarly, Kiyak and Bell25 have
shown that less than 45% of the patients who did not have
video images as a treatment planning aide, were satisfied
with the outcomes of their surgery.
Because the potential impact of video imaging on
patient expectations is significant,21 the accuracy of what is
being shown becomes critical. Recent research relating to
the accuracy of video imaging has examined mandibular
advancement,22,26-28 maxillary impaction,29 canine extrac-
tion,30 and mixed dentition growth modification,31 but
Kazandjian et al 383
class III treatment, and specifically mandibular set-back,
has yet to be evaluated.
The purpose of this study therefore was to compare the
accuracy of two video imaging systems—Quick Ceph
Image (QC) and Portrait Planner (PP)—in predicting the
facial esthetic outcomes of mandibular set-back in surgical
Class III cases. The objectives of the study were twofold:
(1) objective evaluation of the cephalometric visual treat-
ment objectives (VTO) line drawings; (2) subjective evalu-
ation of the video images.
MATERIAL AND METHODS
The sample consisted of 30 patients who met the
following criteria:
1. All patients were nongrowing white adults at least
20 years old.
2. All underwent an isolated bilateral sagittal split
osteotomy (BSSO) in order to set the mandible back
an average of 3.6 mm (range, 1.5 to 8 mm). It is impor-
tant to note that the 3.6 mm as average change was
recorded at the completion of the orthodontic treat-
ment, which was usually 6 to 12 months after surgery.
Thus this value includes any postsurgical relapse.
3. All patients had presurgical and postsurgical ortho-
dontic treatment.
4. The patients had no genetic syndromes or other
congenital deformities.
5. Retrospective pretreatment and posttreatment
cephalometric radiographs and profile photographs
were available for analysis. No orthodontic appli-
ances were present, and the lips were in repose.
The standardized, natural head position, cephalomet-
ric headfilms, and the profile photographs were first
entered in an IBM compatible computer (486sx, 66 MHz),
using a Numonics digitizer (Numonics Corp, Mont-
gomerryville, Pa), a JVC RGB (TK-107OU) camera
(Pentax, Inc, Japan) positioned at a standardized distance
with uniform lighting on a Kaiser copy viewstand and a
Kaiser viewbox (Kaiser Inc, Germany). Portrait Planner
(Rx Data Inc, Ooltewah, Tenn) software was then used to
store the data and generate image predictions.
The same records were also entered in a 7100/66
Power PC Macintosh (Apple Computer Inc, Cupertino,
Calif) computer using a CCD video camera, a color
Sony (Sony Inc, Japan) super eight camcorder, and a
Kaiser Viewbox. Quick Ceph Image (Orthodontic Pro-
cessing, San Diego, Calif) software was then used to
store the data and generate image predictions.
Generation of Line Drawing and Video Image
Predictions
The following technique was used to generate the
cephalometric line drawings and the video image pre-
384 Kazandjian et al
Table I.Video image scores: Comparisons between raters
Orthodontists
Upper lip 63.1 ± 22.5
Lower lip 57.3 ± 21.6***
Labiomental fold 61.5 ± 20.3***
Chin 54.1 ± 21.8***
Throat area 61.5 ± 20.7***
Overall 52.1 ± 18.1***
***P < .001 (for this group compared to the other two groups).
dictions for both programs. To assess the horizontal and
vertical mandibular changes that occurred during treat-
ment, the pretreatment and posttreatment cephalograms
were superimposed on the cranial base (SN) registered
at sella. The actual anteroposterior and vertical changes
that occurred during treatment were measured at pogo-
nion and using these numbers, a computer-generated
VTO was produced. A regional superimposition of the
mandible (Björk technique)32 was also performed to
determine any presurgical orthodontic movement of the
lower incisors. Using the morphing function in both
programs, video image predictions were then generated
for these known surgical changes. No smoothing or
blending functions were used to generate the video
images. The video predictions were then analyzed as
follows:
Line Drawing Measurements
X and Y axes were constructed using SN and a per-
pendicular to SN starting at sella. Differences in mil-
limeters between the computer-predicted and the actu-
al final VTOs were determined at the following eight
specific points in both X and Y axes: (1) subnasale, (2)
upper lip anterior, (3) stomion superior, (4) stomion
inferior, (5) lower lip anterior, (6) labiomental fold, (7)
soft tissue pogonion, and (8) soft tissue menton. When
using Quick Ceph Image (QC), the measurements were
made within the program using a custom analysis. In
Portrait Planner (PP) this application was not available,
so a caliper was used to make comparable measure-
ments on printed line drawings to the nearest 0.1 mm.
To ensure size compatibility between the two sets of
computer-generated line drawings, all PP measure-
ments were corrected for magnification before any
comparisons were made, using the original sella-nasion
distance as a baseline.
Video Image Evaluations
For each program in randomized order color slides
of the initial, actual final, and video image predictions
were displayed simultaneously on a screen side by side.
The smoothing and blending functions available in the
American Journal of Orthodontics and Dentofacial Orthopedics
April 1999
Oral surgeons Lay people
59.5 ± 25.2 49.5 ± 15.5***
44.4 ± 27.4 45.4 ± 16.7
41.2 ± 26.7 41.0 ± 17.7
36.1 ± 26.3 40.5 ± 16.5
52.4 ± 28.7*** 45.9 ± 15.6***
39.4 ± 22.3 40.3 ± 13.8
programs were not used to produce these images
because this would introduce subjective variables.
These images were then evaluated by a rating panel
composed of two orthodontists, two oral and maxillo-
facial surgeons, and two lay people. Each evaluator’s
perception of accuracy between the actual posttreat-
ment photograph and the predicted video image was
evaluated with the Visual Analog Scale (VAS) ranging
from poor to excellent on a 100 mm line. Each evalua-
tor was asked to mark a point on the line denoting their
perception of the prediction’s accuracy compared with
the actual result. The evaluators, who were not mem-
bers of the study team, were given common instruc-
tions on the use of the scale before actual scoring took
place. Assessments were made at the following areas:
upper lip, lower lip, labiomental fold, chin, throat, and
overall profile (Table I).
Error Analysis and Statistics
A multiple analysis of variance (ANOVA) test (three
factor factorial in complete randomized design) was
employed to examine whether there were any subjective
differences between QC and PP, and between ratings of
the orthodontists, surgeons, and lay people. Where dif-
ferences were noted, paired t tests were performed to
determine the areas for which QC and PP, and the three
groups of raters, significantly differed. The level of sig-
nificance was set at 0.05 after a power analysis was per-
formed. A reproducibility study to examine intra-exam-
iner error was done. For the VTOs, 10 cephalometric
films were retraced and redigitized for both programs by
the same operator (S.K.). The measurements were com-
pared to the initial ones using a paired t test. The opera-
tor was found reliable (P < .05). For the video images, 10
patients in each program (QC and PP) were reexamined
and rescored by every rater. Scores were then compared
to the initial ones using a paired t test. The examiners
were found to be reliable for all points with the exception
of one examiner’s evaluation of three points. It was
decided to include this data in the study because the
range of error was smaller than the standard deviation for
these parameters.
American Journal of Orthodontics and Dentofacial Orthopedics Kazandjian et al 385
Volume 115, Number 4

Table II. Horizontal axis differences between the actual and the predicted line drawings (VTO) for the two programs
Quick Ceph Image Portrait Planner
(mm) (mm) QC vs PP
X ± SD X ± SD P value

Upper lip
Superior labial sulcus +0.11 ± 2.18 −0.34 ± 2.08 NS
Upper lip anterior +0.48 ± 1.91 +0.16 ± 2.29 NS
Stomion superior +2.25 ± 3.63 +0.22 ± 3.77 NS
Lower lip
Stomion inferior +0.79 ± 2.82 +1.47 ± 3.21 NS
Lower lip anterior +1.05 ± 1.93 +0.63 ± 2.74 NS
Inferior labial sulcus −0.21 ± 2.33 −0.60 ± 2.25 NS
Chin
Soft tissue pogonion −0.44 ± 2.74 −1.61 ± 3.56 NS
Soft tissue menton −0.80 ± 2.68 +0.14 ± 3.99 NS

SD, Standard deviation.

+, Predicted image larger than the actual image.
40,– Predicted image smaller than the actual image.

Table III. Vertical axis differences between the actual and the predicted line drawings (VTO) for the two programs
Quick Ceph Image (mm) Portrait Planner (mm) QC vs PP
X ± SD X ± SD P value

Upper lip
Superior labial sulcus −0.64 ± 2.61 −0.56 ± 2.50 NS
Upper lip anterior −1.20 ± 2.82 −1.56 ± 2.61 NS
Stomion superior −1.64 ± 2.35 −1.18 ± 2.54 NS
Lower lip
Stomion inferior −2.23 ± 2.85 −1.63 ± 3.33 NS
Lower lip anterior −2.00 ± 3.46 −1.65 ± 5.27 NS
Inferior labial sulcus +0.43 ± 4.98 −0.91 ± 5.19 NS
Chin
Soft tissue pogonion −0.53 ± 4.22 −1.99 ± 6.54 NS
Soft tissue menton −0.72 ± 4.49 −1.46 ± 5.35 0.01

+, Predicted image larger than the actual image.

40, − Predicted image smaller than the actual image.

RESULTS accurate to less than 1 mm. However, none of PP’s pre-

Line Drawing Comparisons (VTO)
In the horizontal plane (Table II), both QC’s and
PP’s computer-generated predictions were accurate to
within 1 mm for 13 of the 16 soft tissue parameters eval-
uated. In general, the largest errors were seen in the area
of the lower lip with both programs tending to underesti-
mate by similar amounts (1.0 to 1.5 mm) the amount of lip
retraction that occurred during surgery. Overall there was
no significant difference (P = NS) between QC and PP in
their horizontal VTO prediction accuracy, although QC
was slightly better at lower lip prediction and PP was
slightly better at upper lip evaluation.
In general, in the vertical plane, the errors noted
(Table III) were bigger than those found in the hori-
zontal plane with only 4 of 8 QC’s parameters being
accurate to within 1 mm; PP showed only 3 parameters
dictions and only 2 of QC’s predictions showed clini-
cally significant errors greater than 2 mm. Both the
upper and lower lips displayed poor results, particular-
ly for the lower lip where errors ranging from 1.6 to 2.3
mm were noted. When comparing the two programs,
both produced errors in a similar direction (ie, VTO
prediction smaller than actual outcome) except for the
inferior labial sulcus, which was underestimated by
QC (ie, VTO bigger than actual outcome). These errors
were not correlated with the magnitude of the setback.
Although the mean prediction accuracy for the
VTOs was fairly acceptable, evaluation of the data’s
distribution showed a large standard deviation with a
significant bipolar spread (Tables IV and V). When the
frequency with which QC and PP produced VTOs
showing less than 1 mm of horizontal error was exam-
ined, an interesting pattern was noticed (Tables IV and
386 Kazandjian et al American Journal of Orthodontics and Dentofacial Orthopedics
April 1999

Table IV. Frequency table of cases showing VTO errors: < 1 mm, 1 to 2 mm, and > 2mm in the horizontal plane
< 1 mm 1 to 2 mm > 2 mm

QC (%) PP (%) QC (%) PP (%) QC (%) PP (%)

Upper lip
Superior labial sulcus 43.3 40.6 26.7 36.7 30.0 23.3
Upper lip anterior 23.3 33.3 43.3 16.7 33.3 50.0
Stomion superior 16.7 30.0 13.3 10.0 70.0 60.0
Lower lip
Stomion inferior 23.3 23.3 20.0 10.0 56.7 66.7
Lower lip anterior 30.0 26.7 33.3 23.3 36.7 50.0
Inferior labial sulcus 23.3 30.0 40.0 30.0 36.7 40.0
Chin
Soft tissue pogonion 30.0 20.0 13.3 36.7 56.7 43.3
Soft tissue menton 36.7 30.0 13.3 13.3 50.0 56.7

QC, Quick Ceph Image.

PP, Portrait Planner.

Table V. Frequency table of cases showing VTO errors: < 1 mm, 1 to 2 mm, and > 2 mm in the vertical plane
< 1 mm 1 to 2 mm > 2 mm

QC (%) PP(%) QC (%) PP (%) QC (%) PP (%)

Upper lip
Superior labial sulcus 23.3 23.3 26.7 30.0 50.0 46.7
Upper lip anterior 30.0 30.0 30.0 30.0 40.0 40.0
Stomion superior 36.7 43.3 23.3 23.3 40.0 33.3
Lower lip
Stomion inferior 33.3 23.3 16.7 20.0 50.0 56.7
Lower lip anterior 23.3 26.7 30.0 16.7 46.7 56.7
Inferior labial sulcus 13.3 13.3 26.7 16.7 60.0 70.0
Chin
Soft tissue pogonion 20.0 10.0 30.0 10.0 50.0 80.0
Soft tissue menton 33.3 16.7 16.7 13.3 50.0 70.0

QC, Quick Ceph Image.

PP, Portrait Planner.

Table VI. Visual analog scale scores of the Video Images

Quick Ceph Image Portrait Planner
X ± SD X ± SD P value

Upper lip 58.7 ± 22.4 56.0 ± 21.9 NS

Lower lip 54.7 ± 22.8 43.4 ± 21.9 ***
Labiomental fold 48.4 ± 23.8 47.5 ± 24.0 NS
Chin 43.6 ± 23.3 43.5 ± 23.1 NS
Throat area 53.9 ± 23.5 52.6 ± 22.8 NS
Overall 46.3 ± 19.8 41.5 ± 15.5 ***

***P < .001

Rating scale: 0, Poor—little agreement between predicted and actual image.
33.3, Fair—prediction acceptable but there were noticeable differences between the actual and the predicted images.
66.6, Good—prediction clinically accurate with only minor differences between the actual and the predicted images.
100, Excellent—prediction indistinguishable from the actual image.

V). Although the mean prediction errors for both pro- showed greater than 2 mm of error due to the large
grams were relatively small, only one third of the para- bipolar spread of the distributions. This explains the
meters actually showed mean errors less than 1 mm and large standard deviations seen for many parameters in
for many measurements more than 40% of the means Tables II and III.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 4
Fig 1. Typical video image prediction from left to right:
initial image, actual final image, and computer-generat-
ed prediction
Although in the lower lip area, QC appeared to be
slightly superior to PP, particularly in the numbers of
cases that showed greater than 2 mm of error, these dif-
ferences were not statistically significant. In the chin
area, it was interesting to note that QC, although hav-
ing a greater number of cases that showed less than 1
mm of error, also had a greater number of cases that
showed greater than 2 mm of error. For soft tissue men-
ton, QC was only slightly better than PP.
In the vertical plane (Table V), the results for the
upper lip area were very similar, with both programs
showing, on average, about 30% of predictions with
less than 1 mm of error, and 40% to 50% of the sample
having less than 2 mm of error. Similarly in the area of
the lower lip, although both programs showed compa-
rable results for the percentage of cases showing less
than 1 mm of error, QC showed, on average a 6% to
10% lower frequency of errors greater than 2 mm than
did PP (P = .05). The chin area in the vertical plane
showed the poorest results overall for the study, with
QC showing over 50% of parameters with errors
greater than 2 mm, whereas PP’s error rate ranged from
70% to 80%.
Video Image Comparisons (Tables I and VI)
Overall, the rating panel evaluated the images as
being in the fair category for both programs, with QC
scoring 5% better than Portrait overall (P < .001)
(Table VI). The best scores were seen in the upper lip,
with both QC and PP being in the good category. The
lower lip was the area where the difference between the
Kazandjian et al 387
Fig 2. Prediction for patient in whom video imaging out-
come was less than satisfactory. Left to right: presurgi-
cal, postsurgical, and computerized prediction images.
two programs was the largest, with QC 9% superior to
PP (P < .001). The lowest ratings were seen in the
labiomental fold and the chin for both programs,
whereas the throat area was somewhat better; the
scores again were similar for both programs.
In comparing the different categories of raters
(Table I), one can notice that in general, the orthodon-
tists gave significantly higher scores (P < .001) for all
areas, except for the upper lip, where the lay people
gave significantly lower scores than the other raters (P
< .001). In the lower lip, labiomental fold, and chin
areas, the orthodontist’s scores were in the good cate-
gory, whereas the other raters’ evaluations were only
fair (P < .001). The throat area showed a graduated
scale of acceptability with orthodontists grading the
highest at 61.5, surgeons were in the middle at 52.4,
and lay people were the least satisfied with a score of
45.9 (P < .001).
DISCUSSION
Even though the cephalometric VTO’s accuracy
found in this study was not as good as that seen in
other studies,22,27,28,30 the video images themselves
were still rated as being in the fair to good category
(Fig 1). Unlike previous video imaging studies that
looked principally at mandibular advancement22,27,28
and involved an expansion of the image’s size, this
study incorporated both anteroposterior and vertical
compression of the images during the mandibular
setback. The problem was most noticeable in the ver-
tical plane, particularly in cases that had competent
388 Kazandjian et al
lips and underwent a significant reduction in facial
height. In these cases, a compression of the nose and
midface was regularly observed. Both programs seem
to act as if they could not compress the lips. They
would treat the rest of the face as a single piece and
compress it instead. This problem has been noted in
other studies,33 and it is clear that further develop-
ment of the video imaging software is needed to
address it (Fig 2).
Both video imaging programs showed very similar
results, despite being significantly different in their
approaches to video imaging, their operating systems,
and hardware. Both programs produced video images
that were consistently smaller (ie, overcompressed) in
the vertical plane, while producing lower lip predic-
tions that were in general more anterior than the actual
results. This suggests a problem with the database used
to generate the morphing algorithms.
In spite of the relatively poor VTO results, the
video images were rated as being fair to good by all
three groups of raters. This suggests that errors of 1 to
2 mm were acceptable clinically and did not represent
a deterrence to the use of this technology for patient
education and communication in Class III treatment.
Most patients recognize that the video image predic-
tions are only an estimation of or a goal for their treat-
ment outcome. They understand that this is only a
computerized simulation and not necessarily an accu-
rate representation of their final appearance. The sim-
ulations, however, do provide patients with visual
goals allaying their fears that the surgical changes may
be so great as to radically change their appearance and
in general meets their “need to know” as to how they
will look after treatment.
There are two critical factors that currently affect the
final accuracy of the video images produced for Class
III treatment. First, it is vital that extremely high-quali-
ty facial photographs and cephalometric radiographs be
taken with reproducible head position and lips at rest.
Failure to meet this goal will result in great difficulty
when combining the VTOs and video images.
Second, the soft tissue ratios used by the software
programs are usually an average of data gathered from
several studies and may not be specific enough to
adjust for individual patient variations in soft tissue
thickness and tonicity. This is particularly true for the
lower lip and is due to the lack of good data on the pre-
dictability of the lower lips’ response to both anterior
and posterior surgical movements. In order to further
improve the accuracy of video imaging, it will be nec-
essary to develop improved algorithms for video imag-
ing that take into account factors such as expansion or
contraction of the image’s size, as well as incorporating
American Journal of Orthodontics and Dentofacial Orthopedics
April 1999
new specific soft tissue ratios that account for individ-
ual patient variability.
CONCLUSIONS
1. For patients undergoing Class III mandibular set-
back, video imaging proved to be accurate enough
for use in communication and patient education.
2. Video imaging proved to be marginally accept-
able as a tool for diagnosis and treatment plan-
ning in Class III surgical cases due to the fact that
30% of the sample showed errors greater than 2
mm in their predictions.
3. Overall, the accuracy of the predictions in this
study was worse than that seen for Class II
mandibular advancements, primarily because of
the difficulty both programs had when compress-
ing the images, particularly in the vertical plane.
4. Both Quick Ceph and Prescription Portrait pro-
duced video images of similar accuracy despite
being significantly different in their approaches to
the video imaging process.
We thank the following for providing us with the
cases used in this study: Dr W. Arnett, Dr H. Aronowitz,
Dr R. Kaminishi, Dr L. Luke, Dr R. McLaughlin, Dr C.
Mossaz, Dr W. Proffit, Dr D. Sarver, and Dr A. Shen.
We also would like to thank Ms. Judy Walter for her
help in the preparation of this article.
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